WEEK 2: Interpretation of Dental Caries

SILICATES

Silicate restorative materials are not used much in today's dentistry. They appear radiolucent on a radiograph.

RAMPANT CARIES

Spreading unchecked. Refers to advanced and severe caries that affects numerous teeth in the dentition. May be seen in children with poor dietary habits or in adults with decreased salivary flow.

Configuration of interproximal caries?

Triangular configuration, with apex of triangle (point of triangle) located toward the DEJ. As it progresses into the DEJ, it spreads laterally, and continues into dentin.

ACRYLICS

Acrylic restorations appear radiolucent on a radiograph.

Caries

Always farther advanced in clinic than what you will seen on a radiograph.

ABRASION ON A RADIOGRAPH

Appears as a well-defined horizontal radiolucency along the cervical region of the tooth.

CERVICAL BURNOUT

Area not covered by bone or enamel is the cervical or neck part of the tooth. This is an area of less radiopacity on the radiograph and thus will appear as a radiolucent band at the neck of the tooth.

OPTICAL ILLUSIONS

Artifacts seen on radiographs that are often mistaken for caries: Peripheral Burnout Cervical Burnout Mach Band Effect Contrast Band Effect

OCCLUSAL CARIES

Best seen CLINICALLY. Early occlusal caries difficult to see radiographically because of the superimposition of the dense buccal and lingual enamel cusps. Becomes apparent radiographically after the DEJ is involved.

BUCCAL AND LINGUAL CARIES

Best seen clinically. Difficult to view radiographically due to the superimposition of the densities of normal tooth structure. When viewed on a radiograph, it appears as a small, circular radiolucency. Hard to distinguish lingual from buccal.

Location of interproximal caries?

Between two adjacent surfaces. Apical to the contact point of the teeth.

ROOT SURFACE CARIES

Bone loss and recession precede root caries. Involves cementum and dentin, NOT enamel. Usually rapid penetration of caries to pulp.

RECURRENT CARIES CAUSE?

Cause: Inadequate cavity preparation. Defective margins. Incomplete removal of caries before the placement of the restoration.

ROOT SURFACE CARIES

Clinically, easily seen on exposed root surfaces. Clinically appear as saucer-shaped with a brown color and leathery texture. Radiographically, appears as a cupped-out or crater-shaped radiolucency just apical to CEJ.

ABFRACTION

Clinically, looks very much like abrasion. Caused by excessive occlusal forces on teeth.

SEVERE INTERPROXIMAL CARIES

Clinically, severe caries may appear as a hole or cavity in the tooth.

CLINICAL ABRASION

Clinically, the area appears hard and highly polished and should not be confused with root caries.

5 caries classification, based on depth and penetration:

Incipient, moderate, advanced, and severe.

Incipient interproximal caries

Involves enamel only. Less than ½ way through enamel. AKA Class I lesion. Tiny radiolucent notch interproximally.

COMPOSITES

Newer composites generally have radiopaque fillers added to the material to make it easier to detect the material radiographically.

Bitewing Radiographs

RADIOGRAPH OF CHOICE FOR THE EVALUATION OF DENTAL CARIES AND EARLY BONE LOSS.

MACH BAND EFFECT

Radiolucent area just below the tooth/amalgam junction. Parallel with the restoration margin. Junction of two different densities. Often confused with caries, except that caries generally is not parallel with the restorative border, and is usually wider.

ABRASION

Refers to the wearing away of the tooth structure from the friction of a foreign object. Most frequent type of abrasion is caused by tooth brushing and is seen at the cervical margin of the teeth.

SEVERE OCCLUSAL CARIES

Seen as a large radiolucency in the dentin. Clinically, seen as a large hole or cavity in the tooth.

5 classifications of caries, based on location?

1. Interproximal 2. Occlusal 3. Buccal 4. Lingual 5. Root

CERVICAL BURNOUT

Can also appear as an ill-defined wedge-shaped radiolucency on the mesial and distal surfaces near the CEJ on posterior teeth. Due to anatomic root concavities found in these areas.

INCIPIENT OCCLUSAL CARIES

Cannot be seen radiographically. Must be detected clinically.

RESTORATIVE MATERIALS

Composites, acrylics and silicates may resemble caries on a radiograph, as they are all radiolucent. They differ from caries in that the restorations generally have well-defined borders and smooth outlines, as opposed to decay that has irregular borders.

CARIES

Demineralization and destruction of hard tooth structures result in a loss of tooth density in an area of lesion. Decreased density allows greater penetration of radiation, thus appearing radiolucent (dark) on film.

MODERATE INTERPROXIMAL CARIES

Extends more than ½ way through enamel, but does not extend to the DEJ. AKA Class II lesion.

SEVERE INTERPROXIMAL CARIES

Extends through enamel and dentin. More than half the distance toward the pulp chamber. AKA Class IV lesion. Involves both enamel and dentin. Radiographically seen as a large radiolucency from the interproximal region into crown of the tooth.

ADVANCED INTERPROXIMAL CARIES

Extends to the DEJ, and into dentin, but does not extend through the dentin more than half the distance toward the pulp chamber. AKA Class III lesion. Involves both enamel and dentin.

CERVICAL BURNOUT

It is the difference in densities of the surrounding structures that cause this to occur. Generally seen on films where there is no alveolar bone loss. Most frequently seen on: MANDIBULAR INCISORS MOLARS

CONDITIONS RESEMBLING CARIES

Many radiolucencies that involve the crown and roots of teeth as seen on radiographs may be mistaken for caries. They can be: Restorative materials Abrasion Attrition Abfraction Optical Illusions

MODERATE OCCLUSAL CARIES

May be seen as a very thin line in the dentin. The thin radiolucency is located under the enamel of the occlusal surface of the tooth. Once the DEJ is affected, the caries spreads laterally and then extends downward toward the pulp.

ATTRITION

Mechanical wearing down on the incisal or occlusal surface of the teeth. Shallow concavities in the dentin appear as occlusal caries. Clinical examination enable the dental professional to distinguish attrition from caries.

CERVICAL BURNOUT

Mistaken for caries. Crown of tooth is covered on the lingual and facial surfaces with enamel (a double coating of enamel for the x-ray to pass through), and the root is covered on the lingual and facial surfaces with bone (double thickness of bone for the x-rays to pass through)

PERIPHERAL BURNOUT

Not really mistaken for caries, but worth mentioning. Edges or interproximal spaces between the teeth seem "wider apart" than they really are. Edges are "burned out" at the periphery of the teeth. This is why one can "open a contact".

RECURRENT CARIES

Observed adjacent to a preexisting restoration. Appear radiolucent just beneath the restoration.

CONTRAST BAND EFFECT

Overlap area (closed contacts) (white or radiopaque on the film.) Contrast bands are the darkened areas just outside the edge of the overlap. Doesn't appear as caries, but can mask the presence of caries on film.

Development of interproximal caries...

Within the dentin, the decay continues forming another triangle, with the base of the triangle at the DEJ and the apex pointed toward the pulp chamber.